Hoag uses virtual reality to take surgery into a new dimension

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Marcus Barnes of Irvine uses Oculus Rift goggles hooked up to the Surgical Theater program to take a virtual tour of his brain. Doctors at Hoag Hospital used the technology to assist them in removing a tumor from Barnes' brain.

Surgical Theatre regional director Jay Sanchez navigates through a 3D model of a skull using the Surgical Theater technology at Hoag Hospital. F-16 fighter pilots use similar technology to prepare for missions.

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Doctors look over a touch screen showing a 3D representation of cancer patient Marcus Barnes' brain. Doctors at Hoag used the Surgical Theater technology to find the best angle to remove Barnes' tumor.

Neurosurgeon Dr. Robert Louis shows how using 3D imaging of the brain can aid surgeons in planning how best to remove a tumor. Hoag Hospital acquired Surgical Theater technology to use on all of its brain cancer patients.

One month after successful brain surgery, the Irvine resident sat in an operating room at Hoag Hospital Newport Beach and was handed a pair of virtual reality goggles.

“There’s your long-gone nemesis,” said Dr. Christopher Duma, neurosurgeon and medical director of the brain tumor program at Hoag Hospital.

“Oh my gosh. This is so cool,” Barnes, 41, said over and over. “This is truly amazing.”

What Barnes saw was a first-hand look at the tumor that was removed from his head – appearing lime green in the 3D model and sitting near a tangle of blood vessels.

Barnes’ virtual-reality trip was built with new technology called Surgical Navigation Advanced Platform, or SNAP, which Hoag brought into the operating room in January. SNAP uses diagnostic images physicians already order, like magnetic resonance imaging (MRIs) and computed tomography (CT), and creates a 3D model that can be used to plan brain surgeries.

Surgeons can manipulate the model on a touchscreen, or wear Oculus Rift virtual reality goggles to do a “fly-through” of the procedure. Hoag became the first non-academic medical institution on the West Coast to use the technology.

Dr. Robert Louis, a neurosurgeon who performed Barnes’ surgery, said he’d planned to access the tumor through Barnes’ eyebrow. But when he looked at the tumor using the 3D model, Louis realized part of the tumor was blocked by Barnes’ optic nerve and would have to be left behind.

By turning the image, he realized he could better reach the tumor – all of the tumor – from the side without affecting any surrounding structures.

“I wouldn’t have known I couldn’t get (the bottom of the tumor) just using the 2D images,” Louis said. “It’s a game changer. Kids playing video games have had this technology for 10 years. It’s amazing we only now get it in the (operating room).”

Typically, a complete change of surgical approach in the final hours before surgery would make patients nervous, Louis said. But with Barnes, he just wheeled out the monitor to his bedside and showed him the change. Barnes still has a video of the surgeon’s explanation on his phone.

“Surgeons get used to seeing things in two dimensions, but the patients don’t. But with the 3D model, they understand like that,” Louis said, snapping his fingers.

The technology, which developers say is partially based on F16 fighter jet simulation, cost Hoag about $500,000, according to Carole Metcalf, executive director of perioperative services at Hoag. Each 3D model takes five to 15 minutes to build in the program, said Jay Sanchez, Western U.S. regional director for SNAP company Surgical Theater.

Duma said the hospital has used the imaging software for about 20 surgeries so far.

“We use it for every single tumor case,” Duma said. “Why would you not?”

Tumors aren’t the only application for SNAP.

Duma pulls up another case on the screen – a patient with trigeminal neuralgia, or burning pain caused by a facial nerve. He said with SNAP he was able to see exactly where a small blood vessel crossed the nerve, and avoid it.

There are also plans to see if it will work for spinal surgeries, he said.

“It’s a brave new world,” Duma said.

Barnes said he has completely bounced back. He’s back at work, and just four weeks after his surgery ran just over nine miles. The plan is to run 15,000 kilometers by the time he’s 45, or just over 9,300 miles, he said.

The tumor, he found out recently, was benign. The only sign of the surgery is a Nike swoop-shaped scar down his hairline.

“I just feel so blessed,” Barnes said.

He jokes that he’s glad his eyebrow was spared, and he can still raise it.